Homer is sent to the hospital, Dr. Hibbert informs him and Marge that he needs a triple bypass, which will cost him $30,000. Hearing this, Homer has another heart attack, increasing the price to $40,000. Without health insurance from work, Marge and Homer figure out a way to pay for the operation.

Homer goes to The Merry Widow Insurance Company, but is denied when he has a heart attack before signing the policy. Marge and Homer then see a commercial for Dr. Nick Riviera, an incompetent surgeon who will perform any operation for $129.95. With no other options, Homer goes for the cheaper service.

Dr. Nick, unfamiliar with the procedure, rents an instructional video, but the important steps of the procedure have been taped over. During Homer's operation, he realizes he does not know what to do. Lisa, watching the operation in the amphitheater, uses her knowledge of cardiology to guide Dr. Nick. The surgery is successful and Homer makes a full recovery.

James L. Brooks had the initial idea for the episode, but the subject matter made some writers uncomfortable.

"Homer's Triple Bypass" was not written by a member of the show's regular staff, but instead Gary Apple and Michael Carrington. They were brought in as freelance writers because the show was suffering from a depleted writing team after the third season ended and the remaining members did not bother to do the episode.

Carrington would provide voice work for later episodes, such as "I Love Lisa" (as Sideshow Raheem), "Homer and Apu" (as the head of the Kwik-e-Mart), and "Simpson Tide" (as Homer's drill instructor).[3] The idea for the episode came from James L. Brooks, who pitched the idea of Homer having a heart attack. However, the writers disagreed with such a heavy topic as this.[4]

They decided to have a scene where Lisa and Bart visit Homer before his surgery and were unsure of how to do it, so they approached Brooks. Brooks made up the entire scene on the spot.[5] Originally, the surgery was supposed to be performed by Dr. Hibbert, but it was later changed to Dr. Nick.[3] In the original airing of the episode, Dr. Nick's phone number was the number of a real legal clinic, whose lawyers made them change it to 1-600-DOCTORB.[3]

The episode's production staff decided that David Silverman would be able to make the episode funny, so he was selected to direct it.[4] He went "all out" and did his best to make Homer's grimaces as humorous as possible, to keep the episode at least somewhat lighter in tone. Silverman added some special touches: for example, when Homer has an out of body experience, his foot was still touching his body to signify that he was not dead. A doctor acted as a medical consultant for the episode.[6]

The episode was to have concluded with Homer eating a pizza in his hospital bed following the operation, and with Marge asking a nurse where the pizza had come from. This reflects the earlier flashback scene where Grampa Simpson watches Homer as an infant, chewing on a slice of pizza in the hospital. The scene was replaced with the family cheering Homer on while he is in intensive care.[5]

The opening sequence of the episode is a parody of American television show COPS; it was not in the original animatic and added later because the episode was too short to fit in its required 22-minute length.[6] When Homer is performing a sock-puppet show to Lisa and Bart, he uses Akbar and Jeff, both of whom are characters from Matt Groening's weekly comic strip Life in Hell.[2][4] Homer follows behind the house that was the birthplace of Edgar Allan Poe, which was placed in the episode by David Silverman. During this scene Homer starts to hear a heartbeat, a reference to Poe's "The Telltale Heart".[6] The scene where Homer sings in a church as a boy is based on the film Empire of the Sun.[5]

In its original broadcast, "Homer's Triple Bypass" finished 16th in ratings for the week of December 14–20, 1992, with a Nielsen rating of 14.3, equivalent to approximately 13.2 million viewing households. It was the highest-rated show on the Fox network that week, beating Married... with Children.[7]

Warren Martyn and Adrian Wood, authors of I Can't Believe It's a Bigger and Better Updated Unofficial Simpsons Guide, called it "a cautionary tale that gives Dr Nick his biggest chance to shine." They also praised the "cloud goes up, cloud goes down" line.[2]IGN noted that the episode "introduced fans to one of the show's more endearing background players, Dr. Nick."[8] Krusty's line "this ain't make-up" is one of Matt Groening's favorite lines from the show.[9]